Take My Midwife, Please

“I have to run off to work, but I just wanted to say ‘Hi,'” says Irma Rodriguez as she plops down on a chair in an examination room at the Bronx-Lebanon Family Practice Center. She stops by to get her birth con-trol from one of the nurses, but Rodriguez is also there to check in and let Dr. Tern Clark-Coller know how things are going. Clark-Coller delivered Rodriguez’ second child two years ago, but she is not a physician. She is a certified nurse midwife with a doctorate in endocrinology.

While the national debate rages over whether midwives are as good as traditional Ob-Gyn physicians, the reality is that many poor women in America are seeing midwives instead of MDs.

According to a new study by the Institute of Urban Family Health (JUFH), an organization that provides health care in poor communities, midwives are at least as effective as traditional obstetricians at providing necessary care. The researchers tracked nearly 400 consecutive births at Bronx-Lebanon hospital and found no significant difference in the number of fetal deaths or intensive care admissions between the women who used the center’s midwives and those who chose a doctor’s care instead.

In 1994, certified midwives delivered more than 200,000 babies nationwide, a 30 percent jump from 1991. And many women in poor New York City neighborhoods are finding that they actually prefer midwives to doctors.

In a struggling neighborhood like the South Bronx, doctors at city clinics and hospital emergency rooms simply don’t have the time for the best kind of preventative patient care, which involves giving women ample opportunity to articulate their problems and concerns. According to a recent study by the American College of Nurse Midwives, an average visit with a midwife is 30 minutes, double the time of an obstetrician.

The time factor is not a minor, bedside-manner consideration. In the community served by the Bronx-Lebanon Family Practice Center, young women face tremendous difficulties: substance abuse, sexually transmitted diseases like AIDS, domestic violence and poor nutrition. As a result, infant mortality is high.

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But others question the over-use of non-doctors in the delivery room. Last year, the New York Times published an article that accused midwives at the city’s public hospitals of overstepping their licensed duties, leading to injury and even death for some infants,

Some obstetricians have argued that the use of midwives is a dangerous cost-cutting measure–especially in high-poverty areas where women and their children run higher risks of complications. A midwife delivery typically costs half that of an in-hospital delivery by an obstetrician.

In the South Bronx clinic, a midwife-doctor cooperation effort has evolved. Midwives oversee only the “normal” pregnancies, referring patients with diabetes, high blood pressure and other high-risk conditions to obstetricians.

“We all have something to bring to the table,” Clark-Coller explains. “We respect the gifts that other people have, and that’s really what makes the team concept work.”

Experts say the key is carefully defining when a midwife’s role ends and a doctor’s begins. But that will be difficult. There are fundamental differences in professional philosophy. Midwives believe in natural childbirth whenever possible, avoiding high-tech medical intervention, such as cesareans, epidurals and fetal monitoring.

However, midwives seem to be popular among mothers exactly because they are reluctant to fastidiously define their roles as doctors do. They are not only medical care providers–they offer emotional support, suggest financial options, and, most importantly they teach young women how to become good mothers.

“What’s really central to this model of care is that we just don’t look at people as a medical problem,” Clark-Coller explains. “You need to see people in the context of their lives and their families.”

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